Check One Dec on 3-4: Neuron & Optogenetics  ____, Microbiome _____

Register the following Industry delegate(s) for this conference:US $1199 ____
Register the following Academia/Government delegate(s):       US $699____
Register the following PhD students: (fax a copy of your id)     US $399____

REGISTRATION COSTS INCLUDES: Break refreshments for two days, but NOT Room accommodation
Poster presentation (Abstract handling fee; Size of Poster W 3ft x L 4ft)      US  $100____

LATE FEE:                  
Registration Charges from Oct 17 to Oct 31:          additional $ 50   __
Registration Charges from Nov 01 to Nov 15:           additional $100  __
Registration Charges from Nov 16 to Nov 30:          additional $150  __
On site Registration (Dec 3 - 4):                                       additional $ 200 __                               
Cancellation policy:             Substitutions are always welcome.      Cancellations before 90days: 70% refund
Cancellations before 60days 50% refund                                  Cancellations before 30 days NO REFUNDS

Name (print first, then last): _________________________________________________________

Title/Designation:                 ______________________________________________________________

Company/Institution: _______________________________________________________________

Address: _________________________________________________________________________

City/State/Zip Code/Country: ________________________________________________________

E-Mail:              ____________________________________________________________________

Phone:  __________________________________  Fax: ____________________________________
Payment Method:
Check enclosed:____                CHECKS CAN BE WRITTEN IN EITHER:   US $   or   UK ₤   or   Euros €  and
Bill my company  ____                     Mail to: PO Box: 540170, Waltham, MA 02454-0170, USA
Charge my credit card: (check one) TRANSACTIONS WILL BE PROCESSED IN US DOLLAR CURRENCY
AmEx____    Visa ____   MasterCard____       Discover____           Billing Address (If different than the above)
 
Card Number: ___________________________________Security Code # (front/back on card):_______

Expiration Date:  __________________________________ Street:___________________________

Name (as shown on card):  ____________________________City/Country:_____________________ Signature of the cardholder _______________________Zip Code:______________________

How did you hear about this meeting? Ad in Journal (circle):  Science, Nature Chemistry, Nano Letter, New-Scientist, The Scientist, Physical Reviews, GES-Email Alert__, GES website__, Poster __, Post Card _, Brochure__, Other Web Ad_ , Referral __.

Substitutions/Cancellation Policy:
In case if your schedule prevents you to attend after registration we will accept a substitute colleague from your company at any time at no charge. However, we have to be notified in advance to prepare badges etc.